A man consulted a dentist, requesting crowns on his front
teeth and a tooth implant to replace a denture on another tooth.
The man told the dentist that he wanted "all his teeth fixed"
before he travelled overseas in the new year. The man agreed to
receive specialist cerec technology treatment, which enabled crowns
to be made by the dentist immediately rather than being made at a
laboratory.

At the initial consultation the dentist took three pre-treatment
X-rays including a posterior bitewing and a periapical film of
teeth 11 and 21. At the first treatment consultation the dentist
took a further x-ray and performed root canal re-treatment on tooth
21 and placed ceramic crowns on teeth 21 and 11. The dentist did
not use a rubber dam when re-treating the root canal. The man said
that he left the clinic with two white crowns alongside his
remaining "very stained" teeth. The dentist told the man that tooth
bleaching would occur after all other treatment had been
completed.

At the second treatment consultation, the dentist performed
crown work on teeth 14 and 24 and placed an on-lay on tooth 36. The
man told the dentist that he was not satisfied with the crown
shape, but the dentist advised him to "leave things as they were
for a few weeks to allow time for adaptation". The man also asked
whether his existing denture (on tooth 22) could be matched to the
colour of his new crowns. The dentist proposed a composite
(veneer) be placed on the denture as a temporary solution. The
treatment plan was not updated to reflect these discussions.

At the last consultation, restorative treatment was completed
and the man's teeth were bleached. The man said that the dentist
was not constantly present during the bleaching process, and after
bleaching there was still a mismatch of shades between the crowns
and the rest of his teeth. The composite (veneer) placed on
the man's denture was described by the man as appearing bulky and
unnatural. The dentist said that he used the best professional
bleach available to bleach the man's teeth and, in his view, the
results were acceptably good.

It was held that by failing to take an X-ray of all teeth that
he was planning to crown, and by failing to use a rubber dam when
re-treating the man's root canal on tooth 21, the dentist failed to
provide services to the man with reasonable care and skill and,
accordingly, breached Right 4(1).

By failing to record details of the treatment options discussed,
advice given, what he encountered clinically, or further treatment
provided, and failing to update the treatment plan, the dentist
failed to comply with professional standards and, accordingly,
breached Right 4(2).

Adverse comment was made that the dentist did not perform a full
mouth X-ray and obtain images of better quality; that he did not
recognise the risks of ongoing colour mismatch given the proposed
order of treatment, and did not communicate this risk to the man;
and that he did not delay crowning of the front teeth until the
implant was ready for restoration.

It was recommended that the dentist provide a written apology
and undertake training on drafting treatment plans, documentation,
and performing X-rays, with assistance from the Dental Council of
New Zealand.